This is a story of a day in the life of 12-year-old Albert Abrams in Brownsville, Brooklyn, during the Depression summer of 1934. Albert’s father is an irascible middle-aged general practitioner whose practice is getting smaller and smaller. Most of his patients can’t pay; and many have left Dr. Abrams to go to younger doctors, or to specialists. Albert’s mother is a refined literary-type lady who never complains about their life in the deteriorating neighborhood, even though all of their middle-class friends have moved elsewhere.

Albert is a brilliant young man ("the highest IQ in the school"), but his greatest desire is to be "one of the boys." He is small, skinny, and poor at sports. The other kids make fun of him because of his "rich" father. The novel describes a long day of verbal and physical harassment; its highlights are a critical punchball game between the white kids, mostly Jewish, and black kids of Longview Avenue, and a fistfight in which Albert actually "beats" one of his perennial nemeses. In the evening there is a fire in which Yussel Melnick, an old Talmudic scholar, is burned to death.

Peeking out from behind his son’s story is the image of Dr. Abrams, a man who once was the star of his medical school class, but whose career long ago failed to "take off" because of his bluntness, bad-temper, and general difficulty getting along with other professionals. He is portrayed as a man truly committed to his patients, but also prone to yelling at them and hounding them for payment. As the day progresses, it becomes evident that Dr. Abrams has been losing his grip; he has episodes of confusion and appears to be on the verge of a nervous breakdown. In the end, stimulated by love for his son, he rouses himself from suicidal ruminations.

By most accounts Dr. Sam Abelman is a failure in life, an irascible old general practitioner who lives in the same grimy Brooklyn neighborhood he has always lived in. He is truculent and tactless, an easy mark for the young specialists who steal his patients. One night a bunch of hoodlums drop a battered young woman on his doorstep. Abelman's nephew, a reporter, publishes a news item about the incident, "Doctor Saves Raped Girl."

Meanwhile, Woody Thrasher, vice president of an advertising agency, is looking for a new type of television show to sell to one of his clients. He comes up with Americans USA, a candid look at "ordinary" Americans who are just doing their jobs, but in an extraordinary way. He decides that Sam Abelman would be the ideal first subject.

Thrasher, a young, high-powered executive, meets Abelman, the last angry man, who summarizes his view on life by saying, "The bastards just won't let you live." The doctor's practice is declining, he can't afford to retire or move away, and the local people certainly don't seem to love him. They don't show gratitude for his services. They don't pay their bills. Many of them consider him a racist, and incompetent to boot. Abelman is clearly not a good candidate for "doctor of the year."

Yet, Thrasher soon finds himself intrigued. Abelman spends hours working in his miniature vegetable garden and reading Henry David Thoreau. He is a brilliant diagnostician, a devoted husband, and an endless campaigner against the "galoots" who think the world owes them a living. Abelman takes aim at "galoots" wherever he finds them, and he finds them everywhere.

The novel interweaves these two men's developing relationship, as Abelman agrees to do the show and Thrasher works to sell it to his bosses, with incidents from Abelman's earlier life. When it turns out that Americans USA will award its subjects their "heart's desire" (in Sam Abelman's case a new house), the doctor declines to go on, refusing to accept "charity" and claiming that Thrasher "tried to crap me up." In the end he agrees to do the show, but suffers a massive heart attack and dies.